BCG (TB) vaccine (where advised)

Who should have the BCG vaccine?

BCG vaccination is recommended on the NHS for babies, children and adults under the age of 35 considered at risk of catching tuberculosis (TB). BCG vaccine isn't given to anyone over the age of 35 as there's no evidence it has any effect in this age-group.

Babies who should have the BCG vaccine

The BCG vaccination is recommended for all babies up to one year old who:

are born in areas where the rates of TB are high

have one or more parents or grandparents who were born in countries with a high incidence of TB

Older children who should have the BCG vaccine

The BCG vaccination is recommended for all older children and adults at risk of TB including:

older children with an increased risk of TB who were not vaccinated against TB when they were babies

anyone under 16 who has come from an area where TB is widespread

anyone under 16 who has been in close contact with someone who has pulmonary TB (TB infection of the lung)

Adults aged 16-35 who should have the BCG vaccine

BCG vaccination is recommended for people between the ages of 16 and 35 who are at occupational risk of exposure to TB including:

laboratory staff who are in contact with blood, urine and tissue samples

veterinary staff and other animal workers, such as abattoir workers, who work with animals, such as cattle or monkeys, that are susceptible to TB

prison staff who work directly with prisoners

staff of care homes for the elderly

staff of hostels for homeless people

staff who work in facilities for refugees and asylum seekers

healthcare workers with an increased risk of exposure to TB

Travellers who should have the BCG vaccine

The BCG vaccine is also recommended for people under the age of 16 who are going to live and work with local people for more than three months in an area with high rates of TB.

Parts of the world that have high rates of TB include:

Africa – particularly sub-Saharan Africa (all the African countries south of the Sahara desert) and west Africa, including Nigeria and South Africa

southeast Asia – including India, Pakistan, Indonesia and Bangladesh

Russia

China

South America

the western Pacific region (to the west of the Pacific Ocean) – including Vietnam and Cambodia

If you want BCG vaccination for yourself or your child, you will be assessed for specific risk factors to TB. If you aren't at risk you won't be eligible for BCG vaccination. If you are at risk, you will be tuberculin tested and offered BCG vaccination according to local arrangements.

The tuberculin skin test/Mantoux test

Before you have the BCG vaccination, you should be tested to see if you are already infected with or have active TB disease. The test, called the tuberculin skin test, or Mantoux test, should be carried out before BCG vaccination if someone:

is six years or over

is a baby or child under six with a history of residence or a prolonged stay (more than three months) in a country with an annual TB incidence of 40 per 100,000 or more

The greater the reaction, the more likely it is that an individual is infected with or has active TB. In this case, the individual should not have the BCG vaccine as it would have no clinical benefit and may cause unpleasant side effects. If you have a strongly positive Mantoux result, you should be referred to a TB specialist team for further assessment.

If the Mantoux test is negative, you can go ahead and have the BCG vaccine.

How is the BCG injection given?

BCG vaccination is given as an injection into the upper arm. If it's advised that your baby has the BCG vaccine, the jab is usually offered soon after birth or while your baby is still in hospital.

Who should not have the BCG vaccination?

The BCG vaccine is not recommended for:

people who have already had a BCG vaccination

people with a past history of TB

people with a positive tuberculin skin test (Mantoux)

people who have had a previous anaphylactic reaction (severe allergic reaction) to any of the substances used in the vaccine

newborn babies in a household where a case of TB is suspected or confirmed

people who have a septic skin condition at the site where the injection will be given

people who have received another live vaccine less than three weeks earlier

people with a weakened immune system, either as a result of a health condition such as HIV, treatments such as chemotherapy or medicines that suppress the immune system such as steroid tablets

people who have cancer of the white blood cells, bone marrow or lymph nodes, such as leukaemia or lymphoma

people who are seriously unwell (vaccination should be delayed until they recover)

pregnant women

BCG vaccinations are not usually offered to people over the age of 16 and never over the age of 35 because the vaccine doesn't work well in adults.